Early federal enrollment data for the 2026 Affordable Care Act (ACA) marketplace plan year indicates a meaningful decline in coverage following the expiration of enhanced premium tax credits, which may have significant implications for hospitals and providers as coverage affordability pressures grow and payer mix volatility increases.
Enrollment Declines Following Subsidy Expiration
As of early January 2026, approximately 22.8 million individuals had enrolled in ACA marketplace coverage, compared with 24.2 million enrollees at the end of the 2025 enrollment cycle, a 5.8% decline in coverage, with 1.4 million fewer enrollees overall.
While enrollment remains open in some states, these figures represent the first major data point illustrating the impact of the expiration of enhanced federal premium tax credits, which had substantially lowered coverage costs in recent years. Importantly, the FY2026 appropriations bill did not extend these enhanced subsidies, meaning many consumers are now facing significantly higher out-of-pocket premium costs.
Current projections suggest that premiums for many enrollees may more than double, on average, in comparison to 2025 costs. Although a bipartisan group of lawmakers continues to discuss potential legislative extensions, no such measure has been enacted to date.
State-Level Enrollment Trends
State-reported enrollment data released by the Centers for Medicare & Medicaid Services (CMS) on January 28, 2026, show uneven but concerning shifts across markets, with several large federally facilitated marketplace states experiencing notable enrollment declines, including Florida, North Carolina, and Ohio.
Other states, including California, Colorado, Minnesota, New Mexico, Idaho, Virginia, and Pennsylvania, reported strong enrollment totals in early snapshots, although year-over-year comparisons remain incomplete.
Overall, the available data suggests a broad downward pressure on coverage uptake across multiple states, rather than isolated market fluctuations.
New Jersey Marketplace Trends
The national coverage shifts are particularly relevant for New Jersey, which operates its own state-based exchange through GetCoveredNJ. In recent years, New Jersey saw record marketplace participation, with more than 500,000 residents enrolled in 2025 coverage, driven in part by enhanced federal subsidies and state outreach initiatives.
However, with the expiration of those subsidies entering the 2026 plan year, many residents are now facing higher net premiums. In response, New Jersey extended its open enrollment period through January 31, 2026, to allow additional time for consumers to evaluate coverage options.
Even so, early data suggests notable shifts in consumer behavior. Among individuals actively shopping for plans, the selection of Silver plans declined from approximately 83% in 2025 to 69% in 2026, while Bronze plan selections increased from 16% to 30%.
At the same time, the share of consumers receiving financial assistance that reduced premiums to $10 per month or less dropped from 48% in 2025 to just 10% in 2026. These changes suggest that consumers are responding to higher premiums by selecting lower-cost plans with higher deductibles and cost-sharing obligations.
Implications for Hospitals and Providers
For healthcare providers, these coverage trends should raise concerns. Even when patients remain insured, higher deductibles and increased cost sharing may lead to delayed care, increased uncompensated care, and growing patient bad debt.
Hospitals and health systems should anticipate continued potential payer mix volatility and greater patient financial responsibility as these market shifts continue to unfold.